Locums: threat or opportunity

The medical workforce is key to service quality. Organisations have a duty to develop their workforce—to ensure professional development, good governance and, from time to time, discipline staff. But what if part of the workforce is contracted from outside to fill gaps in the rota? That is the world of the ‘locum’—a peripatetic medical workforce that is in, but not of, the organisation. Locum doctors are deployed in many countries of the world. There is a thriving international market across English-speaking countries,1 Western Europe2 3 and in the USA, where the Veterans Administration alone pays about $50 million per annum for temporary medical staff.4 Considering the size and importance of this human resources market, the subject has attracted surprisingly little academic attention. Ferguson and colleagues peer into the world of the medical locum through an in-depth qualitative study based on interviews and focus groups.5 Participants included locums, non-locum clinicians and service managers as well as patients, mostly from hospitals and primary care centres in England. The emphasis is on ‘ how locum doctor working arrangements affect quality and safety’ . Based on their previous narrative systematic review,6 the authors claim that they have conducted the largest study on the topic of locums. The authors also claim that the existing literature is ‘ largely contextual’ and does not cover the influence of the broader organisational system on the performance of locums. Ferguson et al ’s study found that the life of the locum is a difficult and lonely one, opening up many pathways to unsafe practice.5 First, it is very difficult for locums to adapt to different procedures and protocols as they move from one organisation to the next, although occasionally this …